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Standardization  for  Tuberculosis 

Wards  or  Pavilions  of 

County  Hospitals 


^ommmmmi 
MAR  22  I960 

LIBRARV 

JiS!!?SITy  OF  QALIFORNIA 


Bureau  of  Tuberculosis 
California  State  Board  of  Health 


California 

State  Printing  Office 

191G 

22436 


STANDARDIZATION  FOR  TUBERCULOSIS  WARDS  OR 
PAVILIONS  OF  COUNTY  HOSPITALS. 


In  determining  the  eligibility  of  hospitals  for  the  state  tuberculosis 
subsidy,  they  will  be  graded  by  the  State  Board  of  Health,  according 
to  location,  construction,  treatment  and  care  of  patients,  and  diet. 

Location  and  grounds — will  count  one  to  five  points. 
Construction  and  type  of  building — one  to  twenty-five  points. 
Treatment  and  care — one  to  thirty-five  points. 
Diet — one  to  thirty-five  points. 

A  hospital  must  receive  a  total  of  eighty  points  to  be  eligible  for  the 
state  subsidj^ 

Location. 

Any  buildings  or  pavilions  to  be  constructed  in  the  future  must  be 
on  a  part  of  the  grounds  separate  from  the  general  hospital.  Counties 
contemplating  construction  must  bear  this  in  mind  and  consult  with  the 
Bureau  before  locating  their  building.  Accessibility,  transportation, 
length  of  time  in  reaching  the  hospital,  and  its  proximity  to  other 
county  buildings  will  be  the  points  on  which  location  will  be  graded. 

Buildings. 

The  Bureau  discourages  the  erection  of  an  expensive  type  of  building 
unless  it  is  a  part  of  a  general  plan  for  a  large  county  or  city  and 
county  hospital.  In  the  smaller  counties,  inexpensive  buildings  have 
been  erected  to  care  for  as  many  as  forty  patients  for  about  $14,000.00. 

Buildings  will  be  graded  on  their  construction  and  on  the  type  of 
building,  also  their  capacity  relative  to  the  need  of  the  tuberculosis 
poor  of  the  county.  They  will  be  classified  as  separate  buildings, 
pavilions,  cottages,  wards  in  a  general  hospital,  "shacks"  or  tent  houses. 

Class  A   Structure. 

A  separate  huilding.- — -It  must  have  proper  accommodations  for  a 
head  nurse ;  sufficient  baths,  toilets  and  lavatories  for  patients ;  a  diet 
kitchen  for  preparing  food  which  can  not  be  transported;  two  kitchen 
sinks  or  adequate  facilities  for  washing  and  disinfecting  dishes.  If 
the  building  is  separate  from  the  general  hospital  and  run  as  a  sana- 
torium, it  must  have  an  examination  room.  There  must  be  isolation 
rooms  for  advanced  cases;  not  less  than  one  isolation  room  for  every 
ten  patients.  In  the  wards,  there  must  be  a  minimum  distance  between 
beds  of  3  feet  6  inches.  "Wards  must  be  sufficienth^  lighted,  preferably 
by  electricity.  Wards  need  not  be  heated,  but  dressing  rooms,  bath- 
rooms and  patients'  dining-room  must  be  heated  in  cold  weather. 

Class   B  Structure. 

A  ward  in  the  general  hospital. — The  requirements  regarding  equip- 
ment and  sufficient  isolation  rooms  and  food  will  be  the  same  as  for 
Class  A.  Class  B  structures  must  have  a  separate  dining-room  for 
ambulatory  patients. 

(2) 


C:  -!■■ 

Class   C   Structure.  HEAIJ 

The  "shack''  hjpe  or  tent  house. — It  can  not  l)e  used  except  for  earlier  lBRai 
cases.     Any  erection  of  a  "shack"  or  tent  house  will  be  discouraged 
unless  a  nursing  force  is  provided  adequate  for  giving  patients  the 
necessary  care. 

Equipment. 

In  structures  of  any  of  the  three  classes,  the  following  requirements 
must  be  met:  In  buildings  having  over  thirty-six  (36)  beds,  one  tub 
or  shower  bath  for  every  twelve  (12)  patients;  one  lavatory  for  every 
six  (6)  patients;  one  toilet  for  every  six  (6)  patients;  two  dental 
lavatories  and  two  slop  sinks  for  every  thirty-six  (36)  patients;  two 
kitchen  sinks  are  desirable.  The  stove  in  the  kitchen  mu.st  be  large 
enough  so  that  if  food  is  to  be  prepared  there,  it  can  be  done  without 
inconvenience. 

There  must  be  back  rests  for  bed  cases ;  ambulatory  cases  must  be 
provided  with  inexpensive  canvas  reclining  chairs.  If  trays  are  used, 
they  must  be  kept  clean.  The  more  expensive  aluminum  trays  last 
much  longer  than  the  common  papier  mache,  which  will  not  be  allowed 
in  the  future.  The  use  of  granite  iron  dishes  and  tin  spoons  is  dis- 
couraged. 

Call  bells  must  be  provided  in  each  w^ard ;  properly  ventilated  lockers 
must  be  provided  for  each  patient ;  scales  also  must  be  provided. 

Wards  and  rooms  must  be  screened  and  wards  and  sleeping  rooms 
must  be  canvassed.    A  platform  or  sun  porch  must  be  provided. 

Treatment   and   Care. 

If  there  is  not  a  resident  staff  connected  with  the  hospital,  a  visiting 
staff  must  be  arranged.  This  can  be  done  through  the  County  Medical 
Society.  There  must  be  one  interne  for  every  fifty  patients.  Daily 
records  must  be  kept.  There  must  be  a  complete  examination  on  admis- 
sion and  frequent  subsequent  examinations.  The  diagnosis  and  type  of 
tuberculosis  must  be  recorded  and  the  complete  record  of  the  patient 
must  be  kept  where  it  is  accessible  to  the  representative  of  the  State 
Board  of  Health.  Temperature  must  be  taken  four  times  a  day  and 
accurate  charts  miLst  be  kept. 

Nursing. 

In  Class  A  buildings  there  must  be  one  registered  nurse  who  has 
had  special  training  in  tuberculosis  nursing,  and  one  nurse  for  every 
sixteen  patients ;  also  one  orderly.  In  Class  B  buildings  nursing  must 
be  supervised  by  the  superintendent  of  nurses,  and  one  pupil  nurse 
provided  for  every  sixteen  patients. 

Admission. 

The  admission  blanks  furnished  by  the  State  Board  of  Health  must  be 
filled  out  in  full  and  sworn  to  by  the  patient  and  the  superintendent 
of  the  hospital. 

Care  of   Patients. 

Adult  patients  must  be  segregated  as  far  as  possible,  according  to  the 
stage  of  the  disease.  Bed  cases  must  be  placed  in  the  smaller  wards,  so 
that  it  will  be  convenient  for  dying  cases  to  be  taken  into  the  isolation 
rooms.     Children  must  be  segregated  in  a  small  ward  of  their  own. 

(3) 

832 


Bedding  must  be  disinfected  after  death  or  removal  of  each  patient. 
Patients  needing  extra  heat  at  night  must  be  given  hot  water  bottles  or 
soapstones. 

Property  of  Patients. 

Provision  must  be  made  for  the  safe  storage  of  any  valuables  or  money 
deposited  b}^  the  patient. 

Food. 

Care  must  be  taken  in  handling  and  serving  food  for  patients  so  it 
will  be  attractive.  There  is  an  enormous  waste  of  food  in  hospitals, 
due  to  the  fact  that  patients  frequently  can  not  eat  the  food  served  them. 
It  must  be  remembered  that  patients  suffering  with  tuberculosis  nearly 
always  have  serious  stomach  disturbances  and  fickle  appetites,  and  the 
serving  of  food  to  these  patients  must  be  done  with  this  in  mind.  If 
the  food  is  to  be  transported  from  the  general  hospital,  it, must  be  sent 
over  in  a  fireless  cooker  or  reheated  before  being  served. 

Tea  must  be  made  in  the  diet  kitchen,  and  coffee,  if  sent  from  the 
general  hospital,  must  be  hot,  when  served.  We  recommend  that  coffee 
and  toast  and  eggs  be  prepared  in  the  diet  kitchen. 

A  suggested  diet  list  will  be  submitted  by  the  State  Board  of  Health. 


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